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首页> 外文期刊>Brachytherapy >Late chest wall toxicity after MammoSite((R)) breast brachytherapy.
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Late chest wall toxicity after MammoSite((R)) breast brachytherapy.

机译：MammoSite（R）乳房近距离放射疗法后晚期胸壁毒性。

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PURPOSE: Accelerated partial breast irradiation (APBI) with the MammoSite breast brachytherapy (MBB) system is being investigated as an alternative to whole breast radiation in breast conservation therapy (BCT) at multiple centers worldwide. The newness of MBB means a complete understanding of long-term toxicity, particularly involving the chest wall, has yet to be completely articulated. We report the first pathologic rib fractures associated with MBB and dosimetric analysis of the original treatment plans. METHODS AND MATERIALS: As part of ongoing quality assurance, we reviewed the records of 129 sequential patients who underwent MBB for breast cancer and identified those who subsequently had clinically significant and radiographically documented rib fracture(s) involving the ipsilateral chest wall. Equivalent tolerance doses yielding a 5% and 50% risk of rib toxicity within 5 years from treatment with 10 fractions (as with MBB) were previously calculated using the linear quadratic equation based on 2Gy per fraction treatments delivered to one-third of the rib volume (TD5/5=37Gy; TD50/5=44Gy). The original radiation therapy plans were evaluated vis-a-vis the plane films or PET/CT images documenting the osseous abnormalities and presenting complaints to find the specific fractured ribs. The specific effected ribs were contoured on the planning CT in "bone windows" using the Nucletron MicroSelectron-classic V2 (Nucletron B.V., Veenendaal, The Netherlands) for this analysis and the original patient treatments. With these datasets, we determined the dose-volume characteristics of the effected ribs including maximal dose encompassing the entire rib on one CT slice, V(20Gy), V(30Gy), V(37Gy), V(44Gy), D(50), D(25), and D(5) (the mean dose to 50%, 25%, and 5% of the rib). RESULTS: Between May 2002 and August 2007, three of 105 patients with a minimum of 6-months follow-up who underwent adjuvant APBI by MBB were found to have a total of five treatment-related rib fractures. The average dose-volume characteristics from the original plans were as follows: D(50)=22.1Gy, D(25)=32.2Gy, D(5)=41.6Gy, max dose to 1cc=34.8, D(max) (to 0.1cc)=45.6Gy, V(20)Gy=57.4%, V(30)Gy=30.8%, V(37)Gy=15.9%, V(44)Gy=6.6%, and max dose through rib=35.8Gy. Two patients sustained two rib fractures and 1 patient had a single rib fracture. Four of five fractures occurred in postmenopausal patients and two of five fractures occurred in a patient with a history of osteoporosis and exposure to adjuvant chemotherapy. CONCLUSIONS: Fractures occurred in ribs with V(37)Gy and V(44)Gy each well below 33%. As long-term toxicity data accrue from APBI series, the traditional models for estimating the biologic equivalent dose may benefit from refinements that specifically address the unique radiobiologic and physical properties intrinsic to high-dose-rate brachytherapy for breast conservation therapy.
机译：目的：在世界各地的多个中心，正在研究采用MammoSite乳房近距离放射治疗（MBB）系统进行的加速部分乳房放射（APBI），以作为全乳放射治疗的替代方案。 MBB的新颖性意味着对长期毒性特别是涉及胸壁的长期毒性有完整的了解，尚待完全阐​​明。我们报告了与MBB相关的首例病理性肋骨骨折和原始治疗计划的剂量分析。方法和材料：作为持续质量保证的一部分，我们回顾了129例行MBB治疗乳腺癌的序贯患者的记录，并确定了随后具有临床意义并经影像学检查证实累及同侧胸壁的肋骨骨折患者。以前使用线性二次方程式，基于每部分2Gy的治疗量（按肋骨体积的三分之一），使用线性二次方程式计算了从10个分数（如MBB）治疗后5年内产生肋骨毒性风险的5％和50％的等效耐受剂量。 （TD5 / 5 = 37Gy; TD50 / 5 = 44Gy）。最初的放射治疗计划是针对平面胶片或记录了骨异常的PET / CT图像进行评估的，并提出投诉以寻找特定的肋骨骨折。使用Nucletron MicroSelectron-classic V2（Nucletron B.V.，Veenendaal，荷兰）在“骨窗”中的计划CT上绘制特定的受累肋骨，以进行此分析和原始患者治疗。利用这些数据集，我们确定了受影响的肋骨的剂量-体积特征，包括在一个CT切片上包含整个肋骨的最大剂量，V（20Gy），V（30Gy），V（37Gy），V（44Gy），D（50 ），D（25）和D（5）（肋骨的50％，25％和5％的平均剂量）。结果：在2002年5月至2007年8月之间，接受MBB辅助APBI辅助的105例至少接受6个月随访的患者中，有3例与治疗相关的肋骨骨折。原始计划的平均剂量-体积特征如下：D（50）= 22.1Gy，D（25）= 32.2Gy，D（5）= 41.6Gy，最大剂量至1cc = 34.8，D（max）（至0.1cc）= 45.6Gy，V（20）Gy = 57.4％，V（30）Gy = 30.8％，V（37）Gy = 15.9％，V（44）Gy = 6.6％，通过肋骨的最大剂量= 35.8Gy。 2例患者发生2处肋骨骨折，1例患者发生1处肋骨骨折。绝经后患者发生五分之四的骨折，骨质疏松病史且接受辅助化疗的患者发生五分之二的骨折。结论：肋骨骨折发生在V（37）Gy和V（44）Gy分别低于33％。由于从APBI系列获得了长期毒性数据，因此估算生物等效剂量的传统模型可能会受益于一些改进，这些改进专门解决了高剂量近距离放射疗法对于乳房保存疗法固有的独特放射生物学和物理特性。

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